August 11th, 2009

Reports the Pittsburgh Post-Gazette:

The couple has spent several weeks trying to straighten out the problem, and they hope their story can be a cautionary tale for the thousands of other seniors, here and elsewhere, who head south for the winter.

“Everybody [to whom] we have told this story cannot believe it,” Mrs. Zihmer said.

The Hampton couple had been getting health coverage through FreedomBlue, a Medicare Advantage PPO plan offered locally through Highmark Inc.

Medicare Advantage plans are administered by private insurers, with some benefits that aren’t standard for those who get medical and hospital insurance through Medicare Parts A and B, such as vision and hearing care coverage.

One advantage of the FreedomBlue plan is the literal freedom that it allows, permitting enrollees to wander from their home bases for up to six months while receiving out-of-network coverage.

“We go away for four months every year,” Mrs. Zihmer said. “That’s why we got FreedomBlue, so we could use it when we left the state. It was more flexible that way.”

But she says her insurer is being inflexible now.

The Zihmers said they returned from Florida on April 28, well before the six-month threshold. Because they failed to notify Highmark that they had returned to Pittsburgh, however, the insurer dropped her coverage.

A June 8 letter, addressed to Mrs. Zihmer, said:

“As you may know, in order to be a member of FreedomBlue PPO, you must not leave the FreedomBlue service area for more than six months. Our records indicate that your absence from our service area has exceeded six months.”

At that point, the Zihmers said it had been only five months.

The letter went on, “If this information is incorrect, please contact before the end of the month [or] you will be disenrolled from FreedomBlue” on July 1, 2009.

Problem is that the letter was sent to the Zihmers’ winter home in Fort Myers Beach, Fla., and they’d been back in Pittsburgh for almost six weeks.

By the time the letter was forwarded to their actual home address in Hampton the July 1 deadline had come and gone. They received the letter on July 13.

“So I was disenrolled by the time we called them the next day,” she said.

Read the rest of the couple’s story at the Post-Gazette.  And comment, please!